Hemodynamics

Your patient has the following hemodynamic values:

SVR = 780

BP = 88/42

CVP = 2

PA = 18/4

SVV = 22%

Based on these values, your patient is probably

• Experiencing an acute MI

• Fluid overloaded

• Significantly vasoconstricted

• Hypovolemic

Your patient was admitted with metastatic lung cancer, is taking chemotherapy, has low urine output, temp - 102.4, BP = 88/46, platelet count = 14,000, lactic acid 9.8, and altered mental status. After assessment, you recognize that the patient needs which of the following?

• IV fluid resuscitation with 30 mL/kg

• Blood cultures after first dose of dual therapy antibiotics

• Stat CT of the head without contrast

• Dobutamine infusion to increase perfusion

The first line drug for refractory hypotension with septic shock is . . .

• Dopamine

• Norepinephrine

• Epinephrine

• Primacor

Which of the following pressures are normal?

• PAP = 34/24; PCWP = 12

• PAP = 30/20; PCWP = 10

• PAP = 28/18; PCWP = 20

• PAP = 24/14; PCWP = 12

Your patient with an inferior wall MI also has RV infarction. He soon develops RV failure. Which of the following data obtained would support this?

• PAP 23/8; PCWP = 19; CVP = 20

• PAP = 54/28; PCWP = 14; CVP = 14

• PAP = 28/19; PCWP = 10; CVP = 20

A normal wedge pressure, increased pulmonary artery pressures, and evidence of right ventricular failure would most likely indicate . . .

• Cardiac tamponade

• Left ventricular failure

• Pulmonary embolism

• Myocardial infarction

Which one of these is NOT a determinant of cardiac output?

• Preload

• Afterload

• Body surface area (BSA)

• Heart rate

• Contractility

A patient in the warm hyperdynamic phase of sepsis will have decreased afterload. Knowing this, infusions that might increase afterload and help with tissue perfusion are all of the following EXCEPT

• Milrinone (Primacor)

• Dopamine

• Norepinephrine (Levophed)

• Epinephrine

• Phenylephrine (Neo-synephrine)

All of the following decrease afterload EXCEPT

• Nitroprusside (Nipride)

• Clevidipine (Cleviprex)

• Hydralazine (Apresoline)

• Milrinone (Primacor)

• Norepinephrine (Levophed)

You have a septic patient with HR = 120, BP = 88/42, Cardiac index = 5.3, oliguria, altered mentation, warm extremities and Cardiac output = 9.2. To improve the patient's blood pressure, the best choice would be:

• Dobutamine

• Phenylephrine (Neo-Syneprhine)

• Epineprhine

• Dopamine